Ovarian cancer recurrence: role of whole-body positron emission tomography using 2-[fluorine-18]-fluoro-2-deoxy-D-glucose

Abstract

This study was designed to assess the value of whole-body positron emission tomography (PET) using 2-[fluorine-18]-fluoro-2-deoxy- D-glucose (FDG) for the diagnosis of recurrent ovarian cancer. Twenty-five patients who had previously undergone surgery for ovarian cancer were imaged using whole-body FDG-PET. During the 4 weeks preceding the PET study, conventional imaging, comprising computed tomography (CT) and magnetic resonance (MR) imaging of the abdomen and/or pelvis, was performed and serum CA125 levels were measured. PET imaging was commenced at 60 min after the intravenous administration of FDG in all patients. PET results were compared with the results of conventional imaging and CA125 levels, and related to pathological findings and clinical follow-up for more than 6 months. FDG-PET showed a sensitivity of 80% (16/20), a specificity of 100% (5/5) and an accuracy of 84% accuracy (21/25) for the diagnosis of recurrent ovarian cancer. The sensitivity, specificity and accuracy of conventional imaging were 55% (11/20), 100% (5/5) and 64% (16/25), respectively. PET could detect recurrent lesions in seven of nine patients in whom conventional imaging was falsely normal, while conventional imaging was true positive in two of four patients with false-negative PET results. The CA125 results showed a sensitivity of 75% (15/20), a specificity of 100% (5/5) and an accuracy of 80% accuracy (20/25). Among the 15 patients with true-positive CA125 results, PET correctly detected abnormal foci of recurrence in 13 patients (86.7%) whereas conventional imaging showed recurrent lesions in only eight patients (53.3%). In conclusion, our preliminary study demonstrates that FDG-PET may be accurate and useful for the detection of tumour recurrence when conventional imaging is inconclusive or negative, especially in patients with abnormal CA125 levels.

Differential Diagnosis of Borderline Ovarian Tumors from Stage I Malignant Ovarian Tumors using FDG PET/CT

“…Contrast MRI enhancement and anatomical features, such as increased septal thickness and solid portion sizes could be helpful, but cannot be used to confidently differentiate these entities [1,13]. Although CA-125 is a well-known biomarker for the detection of ovarian cancer recurrence, with high accuracy and a high positive predictive value [14], CA-125 levels were only found to be marginally increased in patients with BOT [15].…”

18F-fluorodeoxyglucose positron emission tomography in patients with recurrent ovarian cancer: in comparison with vascularity, Ki-67, p53, and histologic grade

“…Until now, clinical application of FDG PET for recurrent ovarian cancer has been relatively limited, with sensitivity ranging from 45% to 100% and specificity from 42% to 100% [4][5][6]. In epithelial ovarian cancer, the size of residual tumor after the primary operation and first-line chemotherapy is important in evaluating chemotherapy response and predicting patients' prognosis.…”

“…However, small disseminated peritoneal lesions in ovarian cancer sometimes cannot be identified using these conventional imaging techniques only, and when small tumors are detected, they cannot always be definitely diagnosed as recurrence. Because F-18 fluoro-2-deoxy-Dglucose positron emission tomography (FDG PET) shows high contrast between tumor and background, its usefulness for diagnosing tumor recurrence and locating recurrent foci has been evaluated in a number of studies [3][4][5][6][7][8][9]. However, the limitation of conventional imaging and FDG PET are their lower diagnostic accuracy in detecting lesions smaller than 1 cm.…”

The Influence of CA 125 and CEA Levels on the Results of 18F-Deoxyglucose Positron Emission Tomography in Suspected Recurrence of Epithelial Ovarian Cancer

“…While Cho et al [2] and Kubik-Huch et al [7] could not demonstrate an improvement of the diagnostic accuracy using PET, other studies did show that FDG PET could be used in this indication with a sensitivity equal to CT/MRI but a markedly better specificity [1,2,7,13,16,[19][20][21]. While Kubik-Huch et al [7] pointed out that, with regard to micrometastatic peritoneal disease, no imaging modality is currently able to substitute a laparoscopic/surgical approach, Nakamoto et al [11] underlined the need for combined morphological (CT/MRI) and metabolic (PET) imaging to obtain optimal results in recurrent OCA.…”